How To Evaluate Figure Skating Injuries
What You Should Know About Skating Boots
Since many acute and chronic injuries are caused by the skating boot itself, it is a good idea to have skaters bring their skates to the appointment for evaluation.1-4
A skate is not just a blade mounted to a boot. The apparatus can vary drastically in regard to the position of the blade, the fit of the boot, any modifications made and the materials used in the construct. Although boot and blade combinations are mass produced and sold cheaply in various sporting good and department stores, competitive skaters will likely obtain their boots from a reputable boot company or dealer, purchase their blades separately and have them properly mounted by a professional.
A custom fitted boot with a quality set of blades can cost in excess of $1,000. Many skaters opt to purchase stock boots, which are a good alternative to the more expensive custom boots in lieu of the expense involved in replacing skates which continue to be outgrown. However, even these stock boot/blade combos can cost hundreds of dollars.
For custom skate boots, the professional fitter will take various foot measurements. (One may take a plaster cast such as that for a custom molded shoe although this is not standard.) The measurements attempt to accommodate for all bony prominences like malleoli as well as other osseous considerations such as hallux abductovalgus deformities. Stock boots may or may not include accommodation for normal bony anatomy but the manufacturer can easily mold or “punch out” the leather of both custom and stock boots.
It is important for podiatrists to know that custom and stock boots lack intrinsic arch support or orthoses although most professional boot companies provide foam box casting services by their personnel at additional cost.
Treating Tendinitis Conditions Related To Boots
Other common tendinitis conditions related to skate boots are that of the extensor hallucis, tibialis anterior and posterior tibial tendons.6 Extensor tendonitis or lace bite results from lateral slipping and compression of the tongue across the top of the foot and ankle with dorsiflexion. One can add midline lace hooks or alternate lacing, or supplement the skate tongue with porous rubber, felt or lamb’s wool in order to treat this problem in conjunction with antiinflammatory medication and ice.
Skating can exacerbate or even cause posterior tibial tendinitis because the standard boot construct lacks intrinsic arch support. Custom orthoses are certainly indicated in this case.
Educating the skater, coach or trainer and/or parents in regard to the etiology of the skater’s condition is essential to ensure compliance. Clinicians should emphasize a gradual return to the ice with off-ice conditioning and a slow increase in the difficulty of moves after returning to the ice. Keep in mind that prior to or during the competitive season (October to March), skaters will be especially anxious to get back on the ice so it is important to have a thorough discussion about the importance of compliance.
The particulars of figure skating are unique to a certain sect of athletes. Clinicians should recognize that youth, finances and external motivation are key factors in a skater’s treatment course. Not only must the health care provider treat the skater’s injury and contributing factors, he or she should educate the skater and his or her support system to ensure there is not a premature return to the ice that risks further aggravation or re-injury.
Dr. Janowicz is a podiatrist for Kaiser Permanente in Oakland, California and a member of the United States Figure Skating Sports Medicine Society.